AIBU to consider suing the NHS?

[BrokenVag]

Today is the 5th anniversary of my child's due date. In reality she was delivered by forceps after a traumatic labour 2 weeks later. During delivery I was given an episiotomy. For various reasons DH and I didn't attempt sex until 6 months later, and it was clear that something wasn't right. I spoke to my HV who told me to see the GP. The GP didn't examine me, and just said that it was probably just the new scar tissue causing problems, and that it would settle down.

Another year passed, we still didn't manage to have sex, and I went to the doctor's again. Saw a female locum who examined me, said all looked fine and that I should just "get over it" (I was crying in pain at being examined). A year later (so DD is 2.5 at this point) I insisted on a referral to see a specialist. The appointment took a year to come through, and as soon as the consultant examined me she said it was highly irregular for a birth in the UK. Turns out I was given a midline episiotomy rather than a median one (the cut went straight down between the muscles rather than diagonally across one). The result is that the muscles went into permanent spasm and pulled against each other, meaning the scar didn't heal (the consultant split it open just examining me - this is 3.5 years after having DD). She suggested botox to stop the muscles pulling apart, and i had the first done last summer (2014). I was recommended to have it checked and a second dose after 6 months.

I had the second dose today, 15 months after the first. Part of the cut has healed, but not all, and again it split when I was examined. Consultant said that it should help, but she's not sure it will ever fix it completely, and the NHS only allows 3 treatments. Given the NHS caused this problem, which has caused significant issues between DH and I as sex is pretty much impossible (I can't even use tampons), WIBU to sue them in the hope that I'll be given whatever treatment is needed to fix the issue?

Op, can I suggest you drop a note to birthrights They are a charity set up to support women who have been badly treated during pregnancy or labour. They have lawyer and health care professional contacts who should be able to help get your questions answered.

Best of luck. You deserve all the support you can get, I hope it gets resolved for you

Thanks. Reading the birthrights site this doesn't appear to be within their remit.

There's no PALS service at the hospital concerned.

The hospital should have a version of pals. They might have rebranded as some sort of patient experience team though, I've come across it in a couple of hospitals.

Might be worth contacting the medico legal department as well and seeing what they advise, requests at my hospital are all redirected to them. Another option would be to go to the trust/ccg headquarters - sounds like a pain in the arse but they should cover your gp, midwife and hospital if they all come under the same trust board.

It's hard to advise since the nhs is (in contrast to public perception) really fragmented. Trying to get a complete picture can involve multiple departments that rarely interact and don't have access to each other's data.

Just to illustrate, my gp comes under the control of a ccg but my midwife operates out of. Different trust to the hospital I attend for my physical care. My gp will get overviews, my midwife will have limited facts stored in her trust and my written detailed info will be eventually stored at the hospital I attend....

It's not simple at all! Worth speaking to as many people as you can before purchasing information though, you should be able to establish were you should target your efforts. My money would be on the hospital who should hold the original written report.

What would of happened if the cut wasn't made.

I think the PALS thing is different in Wales. There is one at another hospital and following it's "success" they're going to roll it out further, but no sign at my local one yet. I can't find any sort of patient liaison team at the hospital or at the health board as a whole. (The health board bit at least is slightly simpler in Wales, so all of the relevant organisations come under the one board.)

Not sure why you would sue as this isn't a failure of care but an awful hazard of childbirth. Even if care wasn't perfect I don't see what gain there is in a lawsuit. It will just add to your life stress.
I think you are being unreasonable but understand you have been in a horrible position and cannot put myself in your place, despite a similar albeit milder experience myself.

What would of happened if the cut wasn't made.

Well, we can play with that all day long. What would have happened if the community midwife had supported my home birth plans? What would have happened if she hadn't insisted that I wasn't in labour when I was? What would have happened if she hadn't told me my baby would die if I didn't go to hospital and be induced? What would have happened if they hadn't induced me when I was already in labour? What would have happened if they hadn't put a faulty clip on DD's head which made it appear that she was in difficulty? What would have happened if they hadn't insisted that I push for 3 hours when I'd not slept for 4 days?

I'm trying very hard to balance my emotional response to the experience with the knowledge that DD came out relatively unscathed (they grabbed so hard with the forceps that they dented her skull permanently, mind you, so it could very easily not have been the case).

A cut was needed for the forceps. As far as I'm aware, it should have been mediolateral though, not midline. I want to know why I was given a midline incision, why I had to suffer for so long before I was taken seriously and referred and why now I'm going to be refused treatment when it's the NHS that caused it!

The reason I ask is because surgeon way up the risks.

Also the cut wouldn't have been made unless yours or the life of your child was in grave danger.

In a court room you will be questioned over this.

Did you or your next of kin consent to this operation

I don't see what gain there is in a lawsuit.

I'm hoping not to need one. All I want is my body repaired. Whether that's by the NHS directly or by them funding private treatment. I don't care. I'm in my mid-30s. Do you really think it's reasonable that I'm never able to have sex again?

I was absolutely off my face and exhausted when the consultant (or whoever it was - I was seeing 4 of everyone) came and said I had another 45 minutes of pushing and then I'd need assistance. She shoved a piece of paper in my face and I scribbled on it. She said that they'd give me a spinal block in case I needed a caesarian, but they really didn't want that because it would probably damage DD. Next thing I know I'm being held still by the midwife while I'm given a spinal block. They tried ventouse - didn't work. They asked for permission (verbally) for forceps. DH asked me, I just wanted her out so nodded and he told them yes. I've no problem with the forceps delivery. It's the placement of the cut that nobody seems to understand.

The information you are looking for is going to be in the hospital notes rather than the GP notes.

The midwife notes would also be helpful to you but they aren't employed by the GP so you would need them from their trust - which is likely to be the same hospital you gave birth in.

Every hospital should have a procedure to send you copies of your notes on request - there is a charge, I think a maximum of £50 and most places will charge the maximum.

PALS is the easiest way to go - even in Wales they will have some sort of equivalent service. Ringing your consultant's secretary and saying you want a copy of all your maternity (both in hospital and from the community midwives) and gynae notes would be a start - they should know who to ask to action this.

I of course agree you should have treatment so you can have sex again. As would everyone. But a lawsuit won't help this at all. You have to accept a long and horrible process to go through a court case. This won't improve either your health nor treatment outcomes.

There is where your problems will be in court.

That both you and DH consented to this.

I do have sympathy for you and I hope you make a recovery.

You should have been examined by the gp. Irrespective of the hospitals actions the gp surely let you down. Good luck.

they consented to a forceps delivery, they didn't consent to the forceps delivery being performed negligently (assuming that is what happened). The Court will be seeking to establish whether the procedure was carried out negligently, not blaming the couple for consenting to the procedure itself.

Well, if the cut was in the wrong place, the NHS should at least pay for the repair! And hopefully for a nice holiday to recover from this ongoing nightmare.
They wrecked your sex life and it would have really made me angry to hear medical people being blase about it.
Get your notes, get specialised legal advice and fight for your rights. You didn't sign a form allowing them to perform a substandard procedure on you.

What would of happened if the cut wasn't made.

Presumably what would have happened is that the surgery would have been carried out correctly without all the horrendous consequences OP has suffered.

I of course agree you should have treatment so you can have sex again. As would everyone. But a lawsuit won't help this at all. You have to accept a long and horrible process to go through a court case. This won't improve either your health nor treatment outcomes.

I don't underestimate the stresses of going through a court process, though it has to be said that, if the evidence supports OP, there is every chance the case would be settled early.

But what mystifies me is the perception that you should only sue if the result of the case will be a direct remedy for medical problems. Kennington, would you seriously suggest that no victim of medical or indeed other negligence should sue unless that will result in the injuries done to them being completely cured? To take a crude example, suppose a surgeon cuts a noted athlete's leg off when mistaking him for another patient. There is nothing that can make him magically grow another leg, and with any luck he will get all necessary surgery, physio, prosthetics etc and home and car adaptations through a combination of the NHS and the disability benefits system. But should the careless surgeon and his insurers in effect get off scott free, whilst the patient's life has been ruined, he has lost his enjoyment of life, and he has been subjected to considerable and ongoing pain and inconvenience? Why should he not receive compensation for all that? Sure, it won't bring his leg back, but he must be entitled to something that improves his life instead, surely?

When I read the original post I was assuming someone was going to be complaining about something trivial but OP, I think in this case you have been treated really badly and they need to get you back into the state you would have been if your original procedure had been carried out properly. I have PM'd you with the name of a top quality specialist who may well be able to help, and I think you should seek sufficient compensation to see this person privately so you can get things sorted as soon as possible. I also think you are owed an apology as at every stage they seem to have let you down.

I think you need to contact the hospital and arrange to have someone go through your notes with you. Due to the way the muscles and skin are stretched as the babys head is coming through, what appears as a lateral episiotomy when the babys head is there, may 'settle' to appear to be midline when the baby is out. Regardless you need to have it sorted, but I do think it would be worth discussing with them what happened first.

It sounds like you've had a really tough time and should definitely push for a second opinion on surgical repair.

As I understand it although mediolateral episiotomies are the most common type in the UK, median episiotomies are still common in other developed countries including the U.S. so you may not be successful if your argument is that median episiotomies are poor practice.

You should write to the hospital with your concerns and ask to sit down with them and go through your labour notes in the first instance

See link for info on types of episiotomy - this says midline can actually heal better?

www.rcm.org.uk/news-views-and-analysis/analysis/how-to-perform-an-episiotomy

You may want to talk to the gynaecologist again to clarify exactly how they felt your episiotomy was incorrectly done

Also- midline and median are the same (Central)

Consultant that's been dealing with the botox treatment is at a different hospital. She says it's a definite midline cut. As I said before, it put the muscles either side into permanent spasm, pulling the wound apart once the stitches had dissolved. The botox should paralyse the muscles sufficiently to allow healing - although she can't paralyse them completely as I'd almost certainly become incontinent. The first dose helped, but it only lasts 6 months, and my second dose didnt take place for 15 months. She split the top part of the scar open just trying to identify where to inject. My DD will be 5 in a few days................